Is Patient Satisfaction Associated with Objective Measures of Geriatric Hip Fracture Care?

Patient satisfaction is publicly reported and used as a subjective measure of quality of care in alternative payment reimbursement models. In this study, we evaluated the association between patient satisfaction scores and objective measures of geriatric hip fracture care. Therefore, according to patient satisfaction score, we investigated the differences for geriatric hip fracture admissions in regard to 1. surgical delay during the index admission and 2. mortality within 1 year.

We identified 65,974 patients between the ages of 60 and 99 years with a primary diagnosis of femoral neck fracture in the New York Statewide Planning and Research Cooperative System database from 2009 to 2014. We evaluated patient satisfaction using annual hospital HCAHPS scores reported on Hospital Compare. Mixed effects regression models controlled for hospital and year of surgery as random effects variables and categorical age, sex, race, insurance, categorical Deyo score, fracture location, and surgical procedure as fixed effects variables.

For high compared to low patient satisfaction hospitals, there were shorter surgical delays (β: -60%, 95% CI: -66% to -52%, p < 0.001) and a lower risk of 1-year mortality (OR: 0.86, 95% CI: 0.78 to 0.93, p < 0.001). For middle compared to low patient satisfaction hospitals, there were shorter surgical delays (β: -37%, 95% CI: -46% to -26%, p < 0.001), but no significant difference in 1-year mortality (OR: 0.94; 95% CI: 0.87 to 1.01; p = 0.091).

Subjective quality, as measured by HCAHPS patient satisfaction scores, is associated with objective quality and clinical outcomes in geriatric hip fracture care. While these findings support the use of patient experience as a component of quality measurement, it remains unclear whether a superior patient experience in itself can increase the value of health care for patients in the form of superior clinical outcomes or if it will lead to increased strain on hospital resources and increase the cost of services, which would paradoxically decrease the value of care.